NPI age
15 years
Enumerated 2010-07-13
Across 5448 active family medicine providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003111758C | |
| 01 | 12263436 | CAQH |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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